T3035 Hospital Incentive Program Vendor Checklist~1.pdf

PDF 151 KB Posted Feb 17, 2017

Attached to: T3035 Hospital Incentive Program
Solicitation number: 17DPP00119
Issued by: Mercer County, New Jersey

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Written by GovTribe AI · Apr 3, 2024

This document is a Procurement Program Checklist from the New Jersey Department of the Treasury Division of Purchase and Property for a solicitation titled "Hospital Incentive Program" with the solicitation number 17DPP00119. The solicitation is for a state and local contract opportunity covering Mercer County and Trenton City. The checklist provides a list of required forms, registrations, and certifications that must be submitted with the vendor quote or proposal, as well as those that are required prior to contract award. Key details include the required submission of an Offer and Acceptance Form, Disclosure of Investment Activities in Iran, Ownership Disclosure, Disclosure of Investigations, Source Disclosure, and Affirmative Action Employee Information Report. The contract opportunity does not provide additional details on the specific products or services requested, quantities, response dates, award dates, or contract term.

The checklist indicates that pricing terms, set asides, incumbent information, funding requirements and sources are not included. Vendors are advised to review the full Request for Proposal (RFP) or bid solicitation, as the RFP language supersedes this advisory checklist in the event of any errors or omissions.

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File	Type	Posted
Revised T3035 Hospital Incentive Program RFP.docx	DOCX document	Feb 17, 2017
T3035 Bid Amendment 2.docx	DOCX document	Feb 17, 2017
T3035 Bid Amendment 4.docx	DOCX document	Feb 17, 2017
T3035 Hospital Incentive Program Price Sheet 21717~2.xlsx	XLSX spreadsheet	Feb 17, 2017
T3035 QA Bid Amendment 7~1.docx	DOCX document	Feb 17, 2017
T3035 Bid Amendment 6~1.docx	DOCX document	Feb 17, 2017
T3035 Hospital Incentive Program SubcontractorUtilizationPlan~1.pdf	PDF	Feb 17, 2017
T3035 Hospital Incentive Program Bid Solicitation 21717~2.docx	DOCX document	Feb 17, 2017
T3035 Bid Amendment 1.docx	DOCX document	Feb 17, 2017
T3035 Bid Amendment 3.docx	DOCX document	Feb 17, 2017
T3035 Bid Amendment 5.docx	DOCX document	Feb 17, 2017
T3035 Hospital Incentive Program Offer and Acceptance Page~2.pdf	PDF	Feb 17, 2017

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New Jersey Department of the Treasury Division of Purchase and Property

PROCUREMENT PROGRAM CHECKLIST

Solicitation Number: ______________________ Solicitation Title: ______________________________________________________

This checklist was created as a guide to assist Bidders in preparing a complete and responsive proposal (quote) as part of the Procurement Program. It is only advisory in nature.

It is the Bidder’s responsibility to ensure that all requirements of the RFP/Bid Solicitation have been met.

Forms with an icon can be accessed through the Maintain General Information section of the Vendor Profile. Forms that have a icon next to them can be accessed on the Division website or by clicking on the icon.

FORMS, REGISTRATIONS AND CERTIFICATIONS REQUIRED BY SECTION 4.4.1

THAT MUST BE SUBMITTED WITH THE VENDOR QUOTE (PROPOSAL)

Offer and Acceptance – MUST BE PHYSICALLY SIGNED AND COMPLETED. SEE RFP

SECTIONS 1.3.4 AND 4.4.1.1

PDF

Disclosure of Investment Activities in Iran - Full Version - SEE SECTION 4.4.1.2.2

PDF

Disclosure of Investment Activities in Iran - Use with completed NJSTART Category ONLY

SEE SECTION 4.4.1.2.2

Ownership Disclosure - Full Version – SEE SECTION 4.4.1.2.1

Ownership Disclosure - Use with completed NJSTART Category ONLY - SEE SECTION 4.4.1.2.1

FORMS, REGISTRATIONS AND CERTIFICATIONS REQUIRED BY SECTION 4.4.2

THAT SHOULD BE SUBMITTED WITH THE VENDOR QUOTE (PROPOSAL)

REQUIRED PRIOR TO CONTRACT AWARD

Disclosure of Investigations and Other Actions Involving Bidder - Full Version - SEE

SECTION 4.4.2.2 PDF

Disclosure of Investigations and Other Actions Involving Bidder - Use with completed NJSTART Category ONLY - SEE SECTION 4.4.2.2

Source Disclosure - SEE SECTIONS 4.4.2.3 AND 7.1.2

ADDITIONAL VENDOR FORMS

Two-Year Chapter 51/Executive Order 117 Vendor Certification and Disclosure of Political Contributions (Instructions included) - SEE SECTION 7.1.1 PDF

Chapter 51/Executive Order 117 Q & A

Affirmative Action Employee Information Report (Form AA302) - SEE SECTION 7.1.3 *Corresponding Instructions & EEO Language

Instructions and EEO Language for Form AA302

Bidders must ensure that all requirements of the RFP have been met as the RFP language supersedes this advisory checklist in the event of an error or omission.

http://www.state.nj.us/treasury/purchase/forms/OfferandAcceptance.pdf� https://www.njstart.gov/bso/� http://www.state.nj.us/treasury/purchase/forms/DisclosureofInvestmentActivitiesinIran.pdf� https://www.njstart.gov/bso/� https://www.njstart.gov/bso/� http://www.state.nj.us/treasury/purchase/forms/OwnershipFinal12-14.pdf� https://www.njstart.gov/bso/� https://www.njstart.gov/bso/� http://www.state.nj.us/treasury/purchase/forms/DisclosureofInvestigations.pdf� https://www.njstart.gov/bso/� https://www.njstart.gov/bso/� http://www.state.nj.us/treasury/purchase/forms/SourceDisclosureCertification.pdf� https://www.njstart.gov/bso/� http://www.state.nj.us/treasury/purchase/forms/eo134/Chapter51.pdf� http://www.state.nj.us/treasury/purchase/forms/eo134/CH51-FAQ.pdf� http://www.state.nj.us/treasury/purchase/forms/AA_%20Supplement.pdf�

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Solicitation Number: 17DPP00119

Solicitation Title: Hospital Incentive Program

File details come from the government source that posted it. Updated Apr 3, 2024.